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Fending Off Cardiovascular Disease

A study of data from over a quarter of a million people confirmed that traditional risk factors for cardiovascular disease (CVD), such as high blood pressure, substantially raise the chance of major CVD events like heart attack or stroke over the course of a lifetime. The finding reinforces the importance of controlling these risk factors.

Past studies of CVD risk factors have tended to focus on a specific age or gender in white populations. They've also generally analyzed risk over defined periods of 10 years or less rather than across a lifetime.

The Cardiovascular Lifetime Risk Pooling Project was designed to collect and pool 50 years of data from numerous studies across the United States. The investigators, led by Dr. Donald M. Lloyd-Jones of the Northwestern University Feinberg School of Medicine, pooled data from 18 studies involving a total of more than 250,000 people—black and white, men and women. The studies all measured traditional CVD risk factors, including blood pressure, cholesterol levels, diabetes and smoking status, at ages 45, 55, 65 and 75. The research project was supported by NIH's National Heart, Lung and Blood Institute (NHLBI), as were several of the studies included in the analysis.

The researchers reported in the January 26, 2012, issue of the New England Journal of Medicine that differences in risk factors translate into marked differences in the lifetime risk of CVD. For example, 55-year-old men with at least 2 major risk factors were 6 times as likely to die from CVD by age 80 as men with none or one CVD risk factor (29.6% vs. 4.7%). Women at age 55 with at least 2 major risk factors were 3 times as likely to die from CVD by age 80 as those with an optimal risk-factor profile (20.5% vs. 6.4%).

When all CVD events—fatal and non-fatal—were considered, the results were even more striking. For example, 45-year-old men with 2 or more risk factors had a 49.5% chance of having a major CVD event by age 80, whereas men with optimal risk-factor levels had only a 1.4% chance. Forty-five-year-old women with 2 or more risk factors had a 30.7% chance of having a major CVD event by age 80, while those with optimal risk-factor levels had a 4.1% chance.

The researchers found that, while black Americans have a higher prevalence of CVD risk factors than white Americans, their lifetime risks are similar when their risk-factor profiles are similar. The study also revealed that traditional risk factors predict the long-term development of CVD more than age.

“These data have important implications for prevention,” Lloyd-Jones says. “We need to get more serious about promoting healthy lifestyles in children and young adults, since even mild elevations in risk factors by middle age seem to have profound effects on the remaining lifetime risks for CVD.”

"Prevention of cardiovascular disease is a lifetime opportunity for and a responsibility of individuals, families, communities and the health care system. This paper reinforces that cardiovascular disease can be prevented and controlled throughout the course of an adult’s lifetime,” says NHLBI Acting Director Dr. Susan B. Shurin.